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OT Hawaii speaker gives update on current use of PRP and stem cells
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KOLOA, Hawaii — According to Jason L. Dragoo, MD, the field of biologics will continue to grow, and the use of these products will become more popular in orthopedic practices.
“Biologics are here to stay. It is time to start incorporating them into our practices,” said Dragoo, during his presentation at Orthopedics Today Hawaii, on the efficacy of platelet-rich plasma (PRP) and stem cell use.
Dragoo noted the most common question about PRP is, “Does it work?” “The good news is there are over 6,000 articles on PRP. The bad news — only half of them show an effect,” he said.
In his review of alternative methods to improve the efficacy of PRP, Dragoo noted that while several studies have shown white blood cell-containing PRP has higher amounts of growth factors compared with PRP without white blood cells (WBCs), it also contains higher amounts of inflammatory mediators. He said level 1 and 2 studies on PRP injected into the knee to treat arthritis symptoms revealed PRP containing WBCs showed no significant results, while studies using PRP without WBCs (neutrophils) showed positive outcomes.
“We also have to examine the amount of red blood cells that we are injecting into the joint,” Dragoo said. “Due to our experience with hemophilia, we know that this can cause arthropathy on its own.”
Arthoscopic harvest of the fat pad containing the stem cells.
Image: Dragoo JL
In regard to the use of PRP for tendinopathy, he said there are currently no clear parameters on whether WBC or non-WBC PRP is the optimal choice. However, Dragoo said multiple, level 1 trials currently being conducted should soon provide the answer to this question.
PRP systems can now concentrate alpha-2-macroglobulin, a molecule that scavenges and removes destructive enzymes. “If you are looking for an anti-inflammatory type of PRP, this may be a reasonable choice,” Dragoo said.
“The good news is, we can harvest stem cells directly from our patients today. We can, add PRP to those stem cells, as well as fibrin glue produced from the patient, then centrifuge them and put them back into the patient, but that is about all we can do thus far, [as per the FDA],” he said.
As far as the use of allograft bone containing live stem cells and the use of amniotic fluid/cells, Dragoo says the jury is still out and “we just need to use caution for these two categories of biologics until further research is done.”
He added the FDA does not allow culturing, sorting or purifying cells, as well as, adding growth factors or enzymes. Dragoo noted orthopedic surgeons have the most experience with mesenchymal stem cells, also known as bone marrow derived cells, and adipose-derived stem cells.
“We need to use caution when using bone marrow aspirate within the joint,” he said. “Most of the bone marrow is composed of white and red blood cells, which may damage the cartilage and synovium.”– by Casey Tingle
Reference:
Dragoo JL. PRP and stem cells: Is there any evidence? Presented at: Orthopedics Today Hawaii; Jan. 18-22, 2015; Koloa, Hawaii.
For more information:
Jason L. Dragoo, MD, can be reached at Stanford University Department of Orthopaedic Surgery, 450 Broadway St., Pavilion A, Redwood City, CA 94063; email: jdragoo@stanford.edu.
Disclosure: Dragoo is a consultant for DePuy/Mitek, Ossur, Moximed, RNL Bio and Beckmen Dickenson; received research support from Linvatec; received fellowship support from Ossur and Smith & Nephew; and received funding from NIH, Sanofi-Stanford BioSTAR Program and Partnership for Clean Competition.